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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 565801637
Report Date: 07/09/2025
Date Signed: 07/10/2025 09:52:59 AM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
This is an official report of an unannounced visit/investigation of a complaint received in our office on
03/11/2025 and conducted by Evaluator Teresa Camara
COMPLAINT CONTROL NUMBER: 29-AS-20250311152417
FACILITY NAME:VETERANS HOME OF CALIFORNIA-VENTURAFACILITY NUMBER:
565801637
ADMINISTRATOR:CYNTHIA GAMBILLFACILITY TYPE:
740
ADDRESS:10900 TELEPHONE ROADTELEPHONE:
(805) 659-7501
CITY:VENTURASTATE: CAZIP CODE:
93004
CAPACITY:60CENSUS: DATE:
07/09/2025
UNANNOUNCEDTIME BEGAN:
12:13 PM
MET WITH:Ray Sena, AdministratorTIME COMPLETED:
02:15 PM
ALLEGATION(S):
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Staff did not accord dignity to resident
Staff did not maintain resident’s medical information confidential
INVESTIGATION FINDINGS:
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Licensing Program Analyst (LPA) Teresa Camara conducted a subsequent complaint investigation visit regarding the above noted allegations. LPA met with Administrator Ray Sena and explained the reason for the visit.

At 12:15 p.m. LPA discussed the allegations with the Administrator. At 1:03 p.m. LPA conducted a telephone interview with the nursing supervisor Selena Lopez, RN. The nurse who was the subject of this complaint was not in as she works the NOC (overnight) shift. However, the nursing supervisor had already spoke with the nurse regarding this alleged incident and provided LPA with the information from their meeting.

(continued on LIC9099C)
Unsubstantiated
Estimated Days of Completion:
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 2
Control Number 29-AS-20250311152417
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)		CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
WOODLAND HILLS N.ASC, 21731 VENTURA BLVD. #250
WOODLAND HILLS, CA 91364
FACILITY NAME: VETERANS HOME OF CALIFORNIA-VENTURA
FACILITY NUMBER: 565801637
VISIT DATE: 07/09/2025
NARRATIVE
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(continued from LIC9099)

Resident 1 (R1) had alleged that Staff 1 (S1) had medical information about them and asked R1 about it. R1 felt their privacy was violated. R1 stated the incident happened in their room.

After speaking with nursing staff and a social worker, LPA decided not to approach R1 regarding this incident as it might be upsetting to R1 and cause psychological setbacks.

During the course of this investigation, it was stated by staff R1 has a history of hallucinations. These hallucinations primarily occurred after R1 had a hospital stay due to a fall. During R1's time at the hospital R1 was prescribed a medication which the nurses felt caused R1 to have hallucinations. The nursing supervisor notified R1's primary care physician (PCP) and since R1's PCP discontinued the medication, R1 is doing better.

The nursing supervisor stated she spoke with S1 about this alleged incident. S1 stated they didn't say anything to R1 about the hallucinations. S1 stated they didn't even recall going into R1's room that night.

The nursing supervisor stated R1 had reported other instances of hallucinations and not recalling conversations with staff. The nursing supervisor stated she believed S1 as she has not had issues with S1; no complaints from other residents.

Based on interviews, these allegations are deemed UNSUBSTANTIATED at this time.

No citations issued. Exit interview conducted and report issued.
SUPERVISORS NAME: Desaree Perera
LICENSING EVALUATOR NAME: Teresa Camara
LICENSING EVALUATOR SIGNATURE:

DATE: 07/09/2025
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 07/09/2025
LIC9099 (FAS) - (06/04)
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